非小细胞肺癌三维适形放射治疗后急性放射性肺损伤分析

Analysis of acute radiation injury in non-small cell lung cancer treated by three-dimensional conformal radiotherapy

目的 探讨非小细胞肺癌（NSCLC）三维适形放射治疗后放射性肺损伤发生的相关因素,为提高NSCLC局部控制率和改善生存质量提供参考.方法 收集2000年8月至2004年12月符合入组条件接受三维适形放疗的非小细胞肺癌患者107例,其中全程三维适形放疗48例,59例前程行传统常规放疗,后程行三维适形放疗.全组患者均为根治性放疗,处方剂量60～78 Gy,中位剂量66 Gy.结果 全组患者放射性肺损伤发生率为62.6%,≥2级放射性肺损伤的发生率为38.3%,其中2级23例占21.5%,3级14例占13.1%,4级4例占3.7%.单因素分析显示,慢性阻塞性肺病、照射野个数、双肺接受的平均剂量、双肺V5～V40对≥2级放射性肺损伤的发生均有显著性影响,其中双肺平均剂量、双肺V20、疗前伴慢性阻塞性肺病为影响放射性肺损伤发生的独立性因素.结论 NSCLC接受三维适形放疗者,应严格限制双肺接受的平均剂量和双肺V20,尤其对放疗前伴有慢性阻塞性肺病者更应高度重视避免严重放射性肺损伤的发生.

Objective To analyze the influencing factors with radiation induced injury of nonsmall cell lung cancer（NSCLC）treated by three-dimensional conformal radiotherapy,in order to supply he reference criteria for optimize the treatment planning of NSCLC, further to improve the local control rate and quality of life of NSCLC patitents.Method From Aug 2000 to Dec 2004,107 NSCLC patients received three-dimensional conformal radiotherapy were enrolled in this study.In all the patients,48 patients accepted three dimensional conformal radiotherapy（3D-CRT）,the other 59 patients accepted conventional radiotherapy（CRT）before later-course of 3D-CRT.All of the patients received the prescription dose between 60-78 Gy and the median dose 66 Gy.Results In the 107 patients,the rate of radiation induced injury was 62.6%.and the rate of≥2 grade was 38.3%.23 cases were classified in grade 2,14 cases in grade 3,4 cases in grade 4.Univariate analysis showed chronic obstructive pulmonary disease,number of beams field,lung mean dose,lung V5-V40 were important influencing factors on radiation induced injury.Further more,lung mean dose,lung V20 and chronic obstructive lung disease were likely to be the independent factors of radiation induced injury by Logistic model.Conclusions lung mean dose,chronic obstructive lung disease and lung V20 were the independent influencing factors on irradiated induced injury.